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General Treatment
Depression/adjustment disorders
Torture/trauma/PTSD

MENTAL HEALTH

Treatment of chronic mental health problems:

General Treatment:

Editors: T. Al-Issa and M. Tousignant
Title: Ethnicity, Immigration, and Psychopathology
Publisher: Plenum Press
Publisher Location: New York
Date: 1997
Hard Copy at CRIIC Library: No
Abstract: unavailable

Authors: Morton Beiser and R. Gary Edwards
Title: Mental Health of Immigrants and Refugees
Journal Name: New Directions for Mental Health Services
Volume, Issue: Number 61
Date: Spring 1994
Page: 73
Hard Copy at CRIIC Library: No
Abstract: Unavailable

Author: Richard C. Cervantes
Title: Mental Health of Immigrants and Refugees: Proceedings of a Conference Sponsored by the Hogg Foundation for Mental Health and the World Federation for Mental Health (Edited by Wayne H. Holtzman and Thomas H. Borneman)
Journal Name: Contemporary Psychology
Volume, Issue: Volume 37, Number 7
Date: July 1992
Page: 663
Hard Copy at CRIIC Library: No
Abstract: Unavailable

Author: C. I. Dahl
Title: Some Problems of Cross-Cultural Psychotherapy With Refugees Seeking Treatment
Journal Name: The American Journal of Psychoanalysis
Volume, Issue: Volume 49, Number 1
Date: March 1989
Pages: 19-32
Hard Copy at CRIIC Library: No
Abstract: Unavailable

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Depression/Adjustment Disorders:

Author: M. Beiser
Title: Influences of Time, Ethnicity, and Attachment on Depression in Southeast Asian Refugees
Journal Name: The American Journal of Psychiatry
Volume, Issue: Volume 145, Number 1
Date: January 1988
Pages: 46-51
Hard Copy at CRIIC Library: No
Abstract: Unavailable

Authors: Dedra Buchwald et al
Title: Prevalence of Depressive Symptoms Among Established Vietnamese Refugees in the United States
Journal Name: Journal of General Internal Medicine: Official Journal of the Society for Research and Education in Primary Care Internal Medicine
Volume, Issue: Volume 7
Date: January 1, 1994
Page: 43
Hard Copy at CRIIC Library: Yes
Abstract: Unavailable

Authors: Z. Porte and J. Torney-Purta
Title: Depression and Academic Achievement Among Indochinese Refugee Unaccompanied Minors in Ethnic and Non-Ethnic Placements
Journal Name: American Journal of Orthopsychiatry
Volume, Issue: Volume 57, Number 4
Date: October 1987
Pages: 536-47
Hard Copy at CRIIC Library: No
Abstract: A study examined the effects of critical elements in the past and present life experiences of Indochinese minors on their adaptation to the U.S. Of particular concern was whether life satisfaction and depression, the balance of American versus ethnic identity, and academic achievement could be predicted on the basis of placement mode (Caucasian or ethnic foster care, group home, or own family). The refugee adolescents who were resettled with ethnic foster families were significantly less depressed and had higher grade-point-averages than those in foster care with Caucasian families or in group homes. The ongoing presence of an adult of similar ethnicity to the adolescent appeared to mitigate against the stress of adaptation to a new country.

Author: A. Schapiro
Title: Adjustment and Identity Formation of Lao Refugee Adolescents
Journal Name: Smith College Studies in Social Work
Volume, Issue: Volume 58, Number 3
Date: June 1988
Pages: 157-81
Hard Copy at CRIIC Library: No
Abstract: An exploratory study was undertaken to ascertain how Laotian refugee adolescents are adjusting to life in the U.S., with particular focus on areas that impact identity formation. Potential problem areas examined were family relationships, school functioning, social status and acceptance, peer relationships, and future planning. The primary stressor encountered by the subjects on their arrival in the U.S. was racial prejudice; other significant factors included academic and language deficits, conflicts with parents, difficulty finding an appropriate peer group, and problems adjusting to lowered social and economic status. All but 3 subjects appeared to be functioning well, although 9 showed signs of depression. Outreach to this group by culturally sensitive and compassionate social workers is warranted.

Author: T. V. Tran
Title: Psychological Traumas and Depression in a Sample of Vietnamese People in the United States
Journal Name: Health and Social Work
Volume, Issue: Volume 18, Number 3
Date: August 1993
Pages: 184-94
Hard Copy at CRIIC Library: No
Abstract: This article investigates the relationships among premigration stresses, nightmares, acculturation stresses, personal efficacy, and depression in a sample of 147 adult Vietnamese Americans. The analysis revealed that premigration stresses, nightmares, and acculturation stresses had significant indirect effects on depression. Acculturation stresses diminish personal efficacy, and a weakness of personal efficacy leads to higher depression. Age, gender, marital status, and English language ability also exert differential effects on premigration stresses, nightmares, acculturation stresses, personal efficacy, and depression. Health care professionals, social workers, health care organizations, and social work researchers should be more culturally sensitive when planning and implementing services and developing research instruments.

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Torture/trauma/PTSD:

Authors: J. Abe, N. Zane, and K. Chun
Title: Differential Responses to Trauma: Migration-Related Discriminants of Post- Traumatic Stress Disorder Among Southeast Asian Refugees
Journal Name: Journal of Community Psychology
Volume, Issue: Volume 22, Number 2
Date: 1994
Page: 121
Hard Copy at CRIIC Library: No
Abstract: Unavailable

Authors: Lynn R. August and Barbara A. Gianola
Title: Symptoms of War Trauma Induced Psychiatric Disorders: Southeast Asian Refugees and Vietnam Veterans
Journal Name: International Migration Review
Volume, Issue: Volume 21, Number 3
Date: Fall 1987
Pages: 820-32
Hard Copy at CRIIC Library: No
Abstract: The symptomology of Southeast Asian refugees suffering from mental health disorders is compared with that of Vietnam war veterans suffering from psychiatric disorders related to war trauma, based on a review of published data. Both of these groups share common unresolved feelings and have similar clinical manifestations resulting from the intensity of wartime atrocities. Similarities in the symptoms presented by these two groups suggest that Southeast Asian refugees may also suffer from the same type of war trauma induced psychiatric disorder as the Vietnam war veterans.

Authors: Eve Bernstein Carlson and Rhonda Rosser-Hogan
Title: Cross-Cultural Response to Trauma: A Study of Traumatic Experiences and Posttraumatic Symptoms in Cambodian Refugees
Journal Name: Journal of Traumatic Stress
Volume, Issue: Volume 7
Date: January 1, 1994
Page: 43
Hard Copy at CRIIC Library: Yes
Abstract: Unavailable

Author: Maurice Eisenbruch
Title: Is Western Mental Health Care Appropriate for Refugees?
Journal Name: Refugee Participation Network
Volume, Issue: Number 11
Date: October 1991
Pages: 25-7
Hard Copy at CRIIC Library: Yes
Abstract: Based on research with Cambodian refugees, the author argues that mental health care should include refugees’ own perceptions of the meaning of their trauma, the way in which they express their distress and an understanding of the strategies they use to overcome it. If refugees express the symptoms of ‘post traumatic stress disorder’, this may be the sign of constructive methods of coping with a devastatingly traumatic experience, and not necessarily indicate a disorder. ‘Western’ approaches to therapy may hence be inappropriate.

Authors: Y. Fischman and J. Ross
Title: Group Treatment of Exiled Survivors of Torture
Journal Name: American Journal of Orthopsychiatry
Volume, Issue: Volume 60, Number 1
Date: January 1990
Pages: 135-42
Hard Copy at CRIIC Library: No
Abstract: Although the symptoms of victims of forced exile and torture can be considered to indicate a type of post-traumatic stress disorder, standard treatment approaches fall short of alleviating the problems of this growing population. A model for time- limited group treatment is presented, and the importance of placing such traumatic experiences in a sociopolitical context is emphasized. The model is illustrated by descriptions of work with a group made up of Central and South American refugees. Theraputic techniques are proposed that focus on symptoms of torture- related post-traumatic stress disorder, allowing members to attain gradual psychological reorganization.

Authors: E. Hauff and P. Vaglum
Title: Organized Violence and the Stress of Exile: Predictors of Mental Health in a Community Cohort of Vietnamese Refugees Three Years After Resettlement
Journal Name: The British Journal of Psychiatry
Volume, Issue: Volume 166, Number 3
Date: 1995
Page: 360
Hard Copy at CRIIC Library: No
Abstract: Unavailable

Authors: E. Hauff and P. Vaglum
Title: Vietnamese Boat Refugees: The Influence of War and Flight Traumatization on Mental Health on Arrival in the Country of Resettlement: A Community Cohort Study of Vietnamese Refugees in Norway
Journal Name: Acta Psychiatrica Scandinavica
Volume, Issue: Volume 88, Number 3
Date: September 1993
Page: 162
Hard Copy at CRIIC Library: No
Abstract: Unavailable

Authors: J. D. Kinzie and J. Fleck
Title: Psychotherapy with Severely Traumatized Refugees
Journal Name: American Journal of Psychotherapy
Volume, Issue: Volume 41, Number 1
Date: January 1987
Pages: 82-94
Hard Copy at CRIIC Library: No
Abstract: Unavailable

Authors: Richard F. Mollica, Grace Wyshak, and James Lavelle
Title: The Psychosocial Impact of War Trauma and Torture on Southeast Asian Refugees
Journal Name: The American Journal of Psychiatry
Volume, Issue: Volume 144, Number 12
Date: December 1987
Pages: 1567-72
Hard Copy at CRIIC Library: Yes
Abstract: More than 700,000 refugees from Southeast Asia have settled in the U.S. since 1975. Although many have suffered serious trauma, including torture, few clinical reports have described their trauma-related symptoms and psychosocial problems. The authors conducted a treatment study of 52 patients in a clinic for Indochinese. They found that these patients were a highly traumatized group: each had experienced a mean of 10 traumatic events and 2 torture experiences. Many of the patients had concurrent diagnoses of major affective disorder and posttraumatic stress disorder as well as medical and social disabilities associated with their history of trauma. The authors also found that Cambodian women without spouses demonstrated more serious psychiatric and social impairments than all other Indochinese patient groups.

Authors: Rachel Yehuda and Alexander McFarlane
Title: Conflict Between Current Knowledge About Posttraumatic Stress Disorder and Its Original Conceptual Basis
Journal Name: The Americal Journal of Psychaitry
Volume, Issue: Volume 152, Number 12
Date: December 1995
Pages: 1705-13
Hard Copy at CRIIC Library: Yes
Abstract: The authors’ goal was the explore the historical, political, and social forces that have played a major role in the acceptance of the idea of trauma as a cause of the specific symptoms of posttraumatic stress disorder (PTSD) and to discuss the impace that current research findings have had on some of the initial conceptualizations of the disorder. The conceptual origins of PTSD are described, and the literature on the prevalence, longitudinal course, phenomenology, and neurobiology of PTSD is reviewed. Paradoxically, there are a series of findings that support the idea that PTSD is a distinct diagnostic entity, but these are different from those originally developed from psychosocial theory and stress research. PTSD has been a controversial diagnosis and is again at a vulnerable point. It is imperative that the field address how current findings challenge the original conceptualizations of this disorder so that the next generation of conceptual issues can be formulated.

Refugee Survivors of Torture: Trauma and Treatment
Professional Psychology: Research and Practice, 2001, vol. 32, no. 5, pp. 443-451(9)
Gorman, W
  Abstracted by: Jaime Rall
Abstract:
Given the author's assertion that the practice of torture has increased in recent years, and the unprecedented numbers of torture-surviving refugees fleeing to the United States, the need for psychologists to be prepared and able to work with torture survivors is increasingly well-documented. Refugees are generally typified by having endured extreme abuses of human rights, and the resulting trauma is often exacerbated by the processes of exile, resettlement, status determinations, and the stresses of cross-cultural transitions. The experience of torture " "the deliberate, systematic or wanton infliction of'suffering" (p. 443) " can be further psychologically debilitating. Common psychological sequelae include "blame and shame", somaticization (experience of physical symptoms in response to psychological concerns), denial, repression, and conditions of helplessness, guilt, depression, or post-traumatic stress disorder [PTSD]. These symptoms often represent techniques for coping with the extreme cruelty of the torture situation that are now maladaptive in a new setting. Unless treated, these symptoms can shut down" and emotionally isolate the person experiencing them. Despite the clear need for psychotherapeutic treatment for torture survivors, there has been a lack of professionals who are qualified, willing, and emotionally prepared to work with this challenging population. In addition, physical health concerns have often been emphasized in refugee services, to the neglect of mental health needs. This article argues that, for reasons of professional responsibility and social justice, psychologists must assist these survivors in their recovery. A well-developed practice framework for serving this population should incorporate knowledge of refugee and torture experiences with multicultural principles, the psychology of trauma recovery and rehabilitation, and concepts of power and liberation. Multicultural competence includes knowledge of cultural contexts, traditions, understandings, and norms, as well as culturally-specific strengths, supports, vulnerabilities, and risks. Trauma recovery principles are central to the treatment of these multiply traumatized clients. Herman's stage model of trauma rehabilitation (1992) is recommended as a treatment framework for torture survivors. The first stage is establishment of immediate safety in the therapeutic relationship and in the environment, by addressing the client's immediate economic, legal, or medical problems before psychological concerns. The second stage is the reconstruction process, by re-visiting, re-interpreting and re-framing the traumatic experiences in terms that are meaningful and affirming to the client. In this stage, the psychologist must also beware vicarious trauma that s/he might experience after hearing horrifying narratives. The third stage is reconnection, with one's own identity and in relationship with others. A multidisciplinary approach to refugee services can facilitate the use of this model. Finally, concepts of power and liberation are integral to the treatment of refugees. The alienation, domination, and defenselessness inherent in the torture situation, and the added dislocation of exile, underscore the client's experience of power relationships. The use of Herman's stage model within a multicultural framework can systematically address the internalized oppression suffered by survivors, and validate the truth of the injustices they have survived. Engaging in psychological interventions with torture survivors is thus an important way that psychologists can meaningfully promote social justice.

Immigrant and Refugee Communities: Resiliency, Trauma, Policy, and Practice
In Practicing Social Justice, 2003 (edited by Stretch, J J, Burkemper, E M, Hutchison, W J, Wilson, J), pp. 135-158(24)
Schmitz C L, Jacobus M V, Stakeman C, Valenzuela G A, Sprankel J
  Abstracted by: Jaime Rall
Abstract:
The unprecedented numbers of refugees migrating to the United States call for a reassessment of community responses to refugee needs. This chapter opens with an overview of the stressors and obstacles facing refugee families and children throughout the displacement process, and that must inform community responses. Refugees experience extreme stress and trauma at various points in displacement: when fleeing their homeland under conditions of persecution, violence, or oppression; when networks, income, social status, security, and support are lost during the migration process; and when enduring substandard living conditions and acculturating to new cultural norms and practices in the host country. Acculturation is particularly stressful inasmuch as interaction with the new culture may disrupt traditional social, familial, and gender roles. The authors also cite restrictive immigration policies in the United States as having made the latter acculturation process even more difficult for many newcomers (e.g. the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), The Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA), and the Anti-Terrorism and Effective Death Penalty Act (AEDP) in 1996). Models are then outlined that can be used in host communities (and specifically by social work professionals in these communities) when crafting creative responses to the challenges facing these populations. According to the authors, "[s]ocially just social services are needed to assist"refugee communities in coping with not only past traumas and conflicts, but also stresses associated with adjusting to their new environments" (p. 145). Social work practice frameworks that underlie socially just" work with refugees are emphasized, with special reference to strengths-focused perspectives, cross-cultural competence, and empowerment practice. With reference to these frameworks, the range of intervention techniques and settings that can serve refugees is broad, including: counseling services, mental health interventions (especially for PTSD, depression, grief and trauma), policy and advocacy activities, community-building activities, mediation between the refugee and needed services, and the development of refugee organizations. Finally, a community exemplar is presented. The small metropolitan area of Portland, Maine, offers a clear demonstration of how refugee resettlement services, the school system, city departments, and other non-profit services can ideally coordinate their work for the benefit and empowerment of refugee families. Available services include trauma recovery, health clinics, grief counseling, language and job training/placement, inclusive policies and programs in the public school system, and advocacy and empowerment services that address larger policy issues and promote the formation of refugee-focused community organizations. This community exemplifies how a holistic community response, typified by well-coordinated networks and multidisciplinary approaches that combine advocacy with community building, empowerment, and recovery/healing services, best serve refugees. The authors close with a call to social work professionals to strengthen their dedication to the needs and rights of immigrants and refugees to the United States, particularly those who may be negatively affected by the political repercussions of the events of September 11, 2001.

Understanding Mental Health Needs of Southeast Asian Refugees: Historical, Cultural, and Contextual Challenges
Clinical Psychology Review , 1 May 2004 , vol. 24, no. 2, pp. 193-213(21)
Hsu E., Davies C.D., and Hansen D.J.
  Abstracted by: Cindy Bosley
Abstract:
Providing mental health services for refugees is challenging for many reasons, most notably language and cultural barriers. Many clinicians tend to make generalizations about refugees as one group, and still others group large geographic regions of refugees together (i.e. Asians). This article explores the historical, cultural, and contextual challenges of providing mental health support to Southeast Asian Refugees (SEARs). After exploring these challenges, the authors then give an overview of common mental health problems among SEARs, followed by an outline of clinical implications. This information is obtained from a variety of prior research over the past 25 years, including numerous clinical research studies. The authors' primary conclusion is that the complex background and experiences of each individual SEAR must be thoroughly examined if any treatment of mental health problems is to be effective. Examining historical factors is important because the type of loss or trauma that a refugee has faced can influence their mental health problems (and associated symptoms) as well as their reactions to treatment. Thus, historical factors should be taken into account during diagnosis and treatment. Cultural factors will also affect the types of mental health problems and their reactions to treatment, but these factors will also influence refugees' attitudes towards treatment and clinicians in general. For example, children and adolescent SEARs often learn English very quickly and thus acquire large responsibilities within their family. Because this runs counter to the value of respecting and obeying elders, SEARs often develop mental health problems because of their conflicting roles within the family. These, and other issues such as gender roles, sexuality, and religious beliefs, must be taken into account when diagnosing and treating SEARs. Contextual factors in the resettlement process can include financial strains, language difficulties, the employment situation, discrimination, safety, and others. These challenges must also be explored to develop a holistic picture of SEARs and their mental health situation. The most common mental health problems among SEARs are depression, anxiety, posttraumatic stress disorder (PTSD), adjustment disorder, and somatization of mental problems. The authors provide numerous statistics of various mental health problems among particular groups with Southeast Asia , as well as statistics among Southeast Asian youth. Resilience against mental health problems among SEARs can be attributed to factors such as language proficiency, presence of close family members, social support networks within the ethnic community, and others. Based on these examinations of the common mental health problems and associated challenges, the authors conclude with an assessment of clinical implications. These implications include recommendations for assessing mental health problems and for treating mental health problems (long and short-term). The primary recommendation of the authors is to approach each patient (or potential patient) as an individual, and explore the often complex situation of each SEAR. Classifying all SEARs into one, monolithic group will only lead to false generalizations, errant diagnoses, and ineffective treatment.

Refugees' Responses to Mental Health Screening: A Resettlement Initiative
International Social Work, 1 April 2003 , vol. 46, no. 2, pp. 235-250(16)
Ovitt N., Larrison C.R., and Nackerud L.
  Abstracted by: Cindy Bosley
Abstract:
Much research has shown a higher incidence of mental health problems among refugees as compared to the general population. In addition to the challenges of treating refugees' mental health problems, there is also a great challenge in diagnosing them. Other research has shown that there are several major barriers preventing or hindering diagnoses and subsequent treatment. These barriers include refugees not seeking help, lack of accessibility of services, linguistic and cultural barriers in diagnosis and treatment, and conflicting resettlement goals. This article describes a small study of a screening test used to identify mental health problems in Bosnian refugees shortly after arriving in the U.S. The screening tool that is used is the Hopkins Symptom Checklist (HSCL-25), which has been translated into four languages, including Bosnian. The HSCL-25 lists common symptoms of various mental health problems, and asks the respondents to identify any symptoms they are experiencing. The checklist was administered to eight recently-arrived, adult Bosnian refugees, and the results showed most of the refugees reporting at least some symptoms of mental health problems, with one refugee meeting the official criteria warranting treatment. The researchers immediately followed the HSCL-25 with a client questionnaire about the screening instrument and process. The client questionnaire asked questions such as: Was the checklist easy to understand, were the items in the checklist upsetting or difficult to answer, and do you feel that this was an appropriate time to consider these kinds of questions? The refugees responded quite positively to the screening process, noting that the HSCL-25 was helpful, important to refugees, and administered as an appropriate time. Most of the eight refugees also indicated that they had not been screened in this manner before in the resettlement process, nor had anyone even asked these types of questions. The overall conclusions of this study are that the HSCL-25 is an appropriate instrument to use with recently-arrived, adult Bosnian refugees resettled in the U.S., and the HSCL-25 can assist mental health professionals in identifying refugees with symptoms of mental health problems.

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